Project Summary/Abstract Approximately 3.6 million breast cancer survivors are living in the US.1 Despite improved survival and relatively low recurrence rates (5-15%),2 the cancer survivorship period is frequently dominated by fear of cancer recurrence (FCR).3 Over half of breast cancer survivors experience moderate to severe levels of FCR,4 with a prevalence of up to 70% among young adults.5 Oncotype Dx, a genomic test analyzing 21 genetic markers of breast cancer tissue, is used to calculate a Recurrence Score (0-100%) to predict the benefit of adjuvant chemotherapy and the likelihood of distant recurrence among patients with early stage, hormone receptor- positive breast cancer.6 Recurrence Scores are divided into three categories of risk: low, intermediate, and high. The associations between Recurrence Score category and FCR, health-related quality of life (HRQOL), psychological distress, anxiety, depression, and perceived risk are poorly understood.7?9 Aligned with NINR?s strategic focus on symptom science and quality of life in individuals with chronic diseases, the proposed study will examine how precision health, in the form of genomic testing, can influence the psychosocial wellbeing and HRQOL of breast cancer survivors. Findings can be used to better understand individual risk for psychosocial sequelae based on genomic risk category and ultimately, to develop personalized symptom interventions to improve HRQOL. Among women with Oncotype Dx testing for stage I ? IIIa hormone receptor-positive breast cancer (? 18 years of age) who have completed adjuvant chemotherapy and are currently on endocrine therapy, the proposed study will: (1) examine the associations between Recurrence Score category (measured by Oncotype Dx: low, intermediate, high) and the primary outcomes, FCR (Concerns about Recurrence Scale (CARS)) and HRQOL (Patient-Reported Outcome Measurement Information System (PROMIS) ? Global Health) and secondary outcomes, psychological distress (Distress Thermometer), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and perceived risk (Illness Perception Questionnaire- Revised and 1 item rating perceived risk of recurrence (0-100%)); (2) determine if phenotypic characteristics, including sociodemographic and clinical characteristics (e.g., age, race/ethnicity, socioeconomic status, education, marital status), are associated with FCR; (3) explore potential discordance between FCR and Recurrence Score category; and (4) explore FCR and psychosocial response using semi-structured interviews with a sub-sample of participants drawn from each Recurrence Score category. The proposed study will use an explanatory sequential mixed methods design. The research will take place at the New York University Perlmutter Cancer Center, a large urban NCI-designated cancer center. Participants will be identified by oncology practice health care providers and the PI during routine visits, support groups, and/or other survivorship center activities.